Treatment tolerability and outcomes in elderly patients with head and neck cancer

Abstract

Purpose: The number of elderly patients with head and neck squamous cell carcinoma (HNSCC) continues to grow. Management of this cohort remains poorly defined. We investigated treatment tolerability and clinical outcomes in this underrepresented population.

Methods: We identified patients aged ≥70 with nonrecurrent, nonmetastatic HNSCC treated curatively from 2007-2018 and analyzed clinical covariates.

Results: Two hundred and twenty patients with a median age of 75 (interquartile range:72-80) were identified. Age and comorbidities were not correlated with toxicity (P ≥ .05). Patients who experienced a treatment interruption had significantly greater weight loss (P = .042) and worse overall survival (OS) (P < .001), but not worse disease-specific survival (P = .45), or locoregional control (P = .21).

Conclusions: Treatment interruptions were associated with weight loss and worse OS, but not disease related outcomes, suggesting an interruption in the elderly may be a surrogate for another issue. In sum, our data should guide clinical trial design to benefit this growing, neglected cohort.

Keywords: elderly; geriatric; head and neck cancer; squamous cell carcinoma; treatment tolerability.

FIGURE 1

Kaplan–Meier survival curves stratified by site. (A) Overall survival for patients stratified by primary site. Three-year overall survival was 78.1% (95% CI: 69.3–88.2), 59.3% (95% CI: 44.2–79.5), 34.6% (95% CI: 20.0–59.8), 55.1% (95% CI: 33.6–90.3), and 100.0% (95% CI, 100.0–100.0) for tumors originating in the oropharynx, larynx, oral cavity, hypopharynx, and nasopharynx respectively (P < .001). (B) Disease-specific survival for patients stratified by primary site. Three-year disease-specific survival was 87.4% (95% CI: 79.9–95.6), 82.1% (95% CI: 70.6–95.6), 60.5% (95% CI: 45.5–80.5), 59.3% (95% CI: 37.0–95.1), and 100.0% (95% CI, 100.0–100.0) for tumors originating in the oropharynx, larynx, oral cavity, hypopharynx, and nasopharynx, respectively (P = .003). (C) Locoregional control for patients stratified by primary site. Three-year locoregional control was 83.7% (95% CI: 74.6–94.0), 75.5% (95% CI: 62.1–91.8), 51.0% (95% CI: 30.0–86.7), 74.1% (95% CI: 52.6–100.0), and 80.0% (95% CI, 51.6–100.0) for tumors originating in the oropharynx, larynx, oral cavity, hypopharynx, and nasopharynx respectively (P = .012)

FIGURE 2

Kaplan-Meier survival curves stratified by age. (A) Overall survival for patients stratified by age. Three-year overall survival was 70.7% (95% CI: 62.9–79.5) and 48.7% (95% CI: 34.2–69.5) for patients age 70–80 and > 80, respectively (P = .007). (B) Disease-specific survival for patients stratified by age. Three-year disease-specific survival was 82.3% (95% CI: 75.7–89.5) and 73.0% (95% CI: 60.3–88.3) for patients age 70–80 and > 80, respectively (P = .27). (C) Locoregional control for patients stratified by age. Three-year locoregional control was 77.9% (95% CI: 70.4–86.2) and 64.7% (95% CI: 45.5–91.9) for patients age 70–80 and > 80, respectively (P = .29)

FIGURE 3

Kaplan-Meier survival curves stratified by performance status. (A) Overall survival for patients stratified by performance status. Three-year overall survival was 81.2% (95% CI: 69.3–95.2), 63.1% (95% CI: 53.3–74.8), and 48.0% (95% CI: 33.9–68.0) for patients with ECOG 0, ECOG 1, and ECOG 2 or 3 performance status, respectively (P < .001). (B) Disease-specific survival for patients stratified by performance status. Three-year locoregional control was 92.2% (95% CI: 83.4–100.0), 78.0% (95% CI: 69.4–87.6), and 64.0% (95% CI: 49.5–82.8) for patients with ECOG 0, ECOG 1, and ECOG 2 or 3 performance status, respectively (P = .001). (C) Locoregional control for patients stratified by performance status. Three-year locoregional control was 84.8% (95% CI: 72.3–99.5), 74.4% (95% CI: 64.8–85.4), and 62.6% (95% CI: 44.3–88.5) for patients with ECOG 0, ECOG 1, and ECOG 2 or 3 performance status, respectively (P = .019)

FIGURE 4

Kaplan-Meier survival curves stratified by AJCC eighth edition staging. (A) Overall survival stratified by stage. Three-year overall survival was 73.7% (95% CI: 63.4–85.8) and 58.3% (95% CI: 48.8–69.6) for patients with stage I/II and stage III/IV tumors, respectively (P < .001). (B) Disease-specific survival stratified by stage. Three-year locoregional control was 89.8% (95% CI: 82.6–97.6) and 71.5% (95% CI: 62.7–81.6) for patients with stage I/II and stage III/IV tumors, respectively (P = .002). (C) Locoregional control stratified by stage. Three-year locoregional control was 79.1% (95% CI: 68.6–91.3) and 72.4% (95% CI: 62.6–83.8) for patients with stage I/II and stage III/IV tumors, respectively (P = .081)

FIGURE 5

Kaplan-Meier survival curves stratified by treatment interruption. (A) Overall survival for patients who experienced a treatment interruption and uninterrupted treatment. Three-year overall survival was 70.1% (95% CI: 61.2–80.3) and 62.5% (95% CI: 51.0–76.5) for patients who experienced uninterrupted and interrupted treatment, respectively (P = .010). (B) Disease-specific survival for patients who experienced a treatment interruption and uninterrupted treatment. Three-year overall survival was 82.5% (95% CI: 75.4–90.3) and 73.6% (95% CI: 62.1–87.2) for patients who experienced uninterrupted and interrupted treatment, respectively (P = .45). (C) Locoregional control for patients who experienced a treatment interruption and uninterrupted treatment. Three-year locoregional control was 82.0% (95% CI: 73.9–91.0) and 68.9% (95% CI: 56.0–84.7) for patients who experienced uninterrupted and interrupted treatment, respectively (P = .21)

FIGURE 6

Kaplan-Meier survival curves stratified by CCI. (A) Overall survival for patients stratified by CCI. Three-year overall survival was 69.5% (95% CI: 60.9–79.2) and 58.0% (95% CI: 46.0–73.2) for patients with a CCI of 5/6 or a CCI ≥ 7 (P = .069). (B) Disease-specific survival for patients stratified by CCI. Three-year disease-specific survival was 82.5% (95% CI: 75.5–90.2) and 75.5% (95% CI: 64.6–87.6) for patients with a CCI of 5/6 or a CCI ≥ 7 (P = .52). (C) Locoregional control for patients stratified by CCI. Three-year locoregional control was 78.4% (95% CI: 70.4–87.3) and 68.5% (95% CI: 53.7–87.4) for patients with a CCI of 5/6 or a CCI ≥ 7 (P = .46)